Ariz. Admin. Code § R9-22-1104 - Mitigating Circumstances
AHCCCS shall consider any of the following to be mitigating circumstances when determining the amount of penalties and assessments.
1. The following are mitigating
circumstances:
a. All the services are of the
same type,
b. All the dates of
services occurred within six months or less,
c. The number of claims submitted is less
than 25,
d. The nature and
circumstances do not indicate a pattern of inappropriate claims for the
services, and
e. The total amount
claimed for the services is less than $1,000.
2. The degree of culpability of a person who
presents or causes to present a claim is a mitigating circumstance, including
but not limited to, if:
a. Each service is the
result of an unintentional and unrecognized error in the process that the
person followed in presenting or in causing to present the service,
b. Corrective steps were taken promptly by
the person after the error was discovered, and
c. The person had a fraud and abuse control
plan that was operating effectively at the time each claim was presented or
caused to be presented.
3.
The financial condition of a person who presents or causes to present a claim
is a mitigating circumstance if the imposition of a penalty, assessment, or
penalty and assessment without reduction will render the provider incapable to
continue providing services. AHCCCS shall consider the resources available to
the person when determining the amount of the penalty, assessment, or penalty
and assessment.
4. AHCCCS shall take
into account other circumstances of a mitigating nature, if in the interest of
justice, the circumstances require a reduction of the penalty, assessment, or
penalty and assessment.
Notes
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